LAUSR

Background Kalamazoo County, Michigan is an urban-rural county with high rates of gestational diabetes among expectant mothers and high disparities in the quality of birth outcomes among its population segments. Analysis of health outcomes in the county has primarily focused on densely populated areas of low socioeconomic status. However, the county has a clear urban to rural continuum. Because women without appropriate access to healthcare during particular stages of pregnancy have poorer outcomes than women with regular access to care, this paper examines the disparities in transportation network accessibility by public transit and private vehicle across the urban-rural continuum. Multimodal accessibility estimates were analyzed especially for individuals relying on Medicaid for perinatal health care from 2012–2014. Methods Reported, confirmed cases gestational diabetes, low birthweight infants and premature births for Kalamazoo County, were retrieved from 2012-14 Michigan birth records. For each case, the dataset includes mother's home address, Medicaid status, race, ethnicity, and an estimate of prenatal care. Batch geocoding was supplemented with extensive manual placement, resulting in an overall address match accuracy of over 90% of cases. Open Trip Planner and Google Maps JavaScript API were used to estimate travel time from census block centroids to pedicatric, obstetric, gynocological and emergency health services by both public vehicle and private transit. Results Individuals in the urban core had the highest multimodal accessibility, because of general proximity to the one central public transit hub. While hospitals are centrally accessible, and all pediatricians, 92 percent of OBGYNs, and 88 percent of family medical locations are transit accessible only 53 percent of pregnant women did not live within 400 m of the bus line. A travel time matrix for this data will be presented at the conference. Several specific areas of concern were identified, such as areas outside the urban core, along a rural continuum which is punctuated by low socioeconomic enclaves of high density, low-income housing (trailer parks). Analysis of Medicaid status and maternal health issues is ongoing. Conclusions Accessibility maps at the census block level have been distributed to community stakeholders. Further analysis of rural health in trailer park communities is imperative. This study has implications for Kalamazoo County health, but also the health of other urban-rural counties across the country with similar vulnerable populations.